Evidence-Based Treatments for Children and Adolescents:

An Updated Review of Indicators of Efficacy and

Effectiveness
Bruce F. Chorpita, University of California, Los Angeles
Eric L. Daleiden, PracticeWise, LLC
Chad Ebesutani, University of California, Los Angeles
John Young, University of Mississippi
Kimberly D. Becker, Johns Hopkins Bloomberg School of Public Health
Brad J. Nakamura, University of Hawaii
Lisa Phillips, PracticeWise, LLC
Alyssa Ward, University of California, Los Angeles
Roxanna Lynch, University of Hawaii
Lindsay Trent, University of Mississippi
Rita L. Smith, University of California, San Francisco
Kelsie Okamura, University of Hawaii
Nicole Starace, University of California, Los Angeles

This updated review of evidence-based treatments fol-
lows the original review performed by the Hawaii Task
Force. Over 750 treatment protocols from 435 studies
were coded and rated on a 5-level strength of evidence
system. Results showed large numbers of evidence-
based treatments applicable to anxiety, attention, aut-
ism, depression, disruptive behavior, eating problems,
substance use, and traumatic stress. Treatments were
reviewed in terms of diversity of client characteristics,
treatment settings and formats, therapist characteris-
tics, and other variables potentially related to feasibility
and generalizability. Overall, the literature
Address correspondence to Bruce F. Chorpita, Department of
Psychology, University of California, Los Angeles, Box
951563, Los Angeles, CA 90095-1563. E-mail: chorpita@
ucla.edu.
expanded considerably since the previous review, yield-
ing a growing list of options and information available
to guide decisions about treatment selection.
Key words: children, dissemination, evidence-based,
services. [Clin Psychol Sci Prac 18: 154–172, 2011]
Numerous reviews of the child and adolescent treatment
literatures have been conducted over the past 30 years
(Lonigan, Elbert, & Bennett-Johnson, 1998; Silverman
& Hinshaw, 2008; Weisz, Hawley, & Jensen-Doss,
2004; Weisz, Weiss, Han, Granger, & Morton, 1995).
Our last comprehensive report (Chorpita et al., 2002)
has preceded several advances, both in the scope and
methods of review and in the children’s mental health
literature. The mental health field in general continues
its focus on evidence-based practice, although there has
been continued controversy over definitions (e.g., APA
Presidential Task Force on Evidence-Based Practice,

 2011 American Psychological Association. Published by Wiley Periodicals, Inc., on behalf of the American Psychological Association.
All rights reserved. For permissions, please email: permissionsuk@wiley.com 154
2006; Barkham & Mellor-Clark, 2003; Lilienfeld, 2007;
Weisz, Sandler, Durlak, & Anton, 2006; Westen,
Novotny, & Thompson-Brenner, 2004). We have iden-
tified over 140 new randomized clinical trials (RCTs)
since 2000, more than the total number in our initial
review (Chorpita et al., 2002). As new perspectives and
new findings emerge, we maintain the position articu-
lated by Stuart and Lilienfeld (2007) as well as others that
the debate is about how evidence should inform clinical
practice, not whether it should.
That said, the manner in which evidence-guided
practice has evolved, from one that emphasized lists of
treatments to a model of evidence-guided decision sup-
port, in which the treatment outcome literature plays a
critical role for some decisions, but not for others (e.g.,
Daleiden & Chorpita, 2005). This distinction is consis-
tent with the distinction between evidence-based prac-
tice in psychology and evidence-based treatments
offered by the APA Presidential Task Force on Evi-
dence-Based Practice in Psychology (2006): ‘‘EBPP
articulates a decision-making process for integrating
multiple streams of research evidence … including but
not limited to…’’ summaries of evidence-based treat-
ments (p. 273). For example, the issue of treatment
selection is perhaps best informed by the treatment
outcome literature, but the decision regarding when to
end an episode of clinical care might be guided by the
outcomes gathered on that child. Thus, reviews of the
outcome literature represent a critical information
source seated in the larger context of an evidence-
informed decision model that prioritizes different
sources of evidence as a function of the different deci-
sions being made.
Another shift in the field is an increasing emphasis
on external validity associated with treatment
approaches (e.g., Weisz et al., 2004). Although the pio-
neering work in the area of classification of evidence-
based treatments initially emphasized indicators of
‘‘effectiveness’’ (Acceptability, Feasibility, Cost ⁄ Benefit;
APA Task Force on Psychological Intervention Guide-
lines, 1995), for years the field has focused on defini-
tions of evidence-based practice that rely almost
exclusively on uniform summaries of indicators of effi-
cacy (‘‘leveling systems’’ using number of replications,
nature of control groups, etc.) with limited or less uni-
form reviews of indicators of effectiveness. Given the
EVIDENCE-BASED TREATMENTS FOR CHILDREN AND ADOLESCENTS • CHORPITA ET AL.
continued growth of the outcome literature, we feel
that these indicators of effectiveness are becoming
increasingly important. For example, 10 successful repli-
cations supporting a particular treatment (assuming the
absence of predictors of differential outcome) would tell
us little about whether that treatment is better suited for
a given child than a treatment supported by only two
replications. In the decision-making framework, those
10 replications are primarily useful to the extent that
they extend the findings to new populations, settings,
or contexts. Perhaps one treatment has been tested with
children whose characteristics are highly similar to the
child in question and another equally efficacious treat-
ment has not, thus guiding our decision toward the
more externally valid match. Overall, perhaps the ‘‘evi-
dence-based’’ label is no longer sufficiently informative.
One other change in emphasis involves the move-
ment toward comprehensiveness as opposed to suffi-
ciency in organizing reviews of the evidence base.
Early work by the APA Division 12 (Task Force on
Promotion and Dissemination of Psychological Proce-
dures, 1995) was implicitly characterized by a suffi-
ciency heuristic, in which a treatment was declared
evidence based when a minimum criterion had been
exceeded (e.g., two or more RCTs). However, to pro-
duce a representative classification of some of the indi-
cators of effectiveness of treatments, it is important to
consider the full literature. Even our initial report,
which strove for comprehensiveness relative to con-
temporary lists of evidence-based practices for children,
indexed only 115 treatment outcome studies in chil-
dren’s mental health. Ironically, the great increase in
the number of published RCTs has led us to focus our
recent review efforts on those designs exclusively,
which is a departure from some of our early methodol-
ogies. Thus, single-subject experimental designs are not
represented in this review, despite their value, particu-
larly with respect to low base rate or atypical child
problems or characteristics. In an attempt to balance
our ideals for a comprehensive review with the feasibil-
ity issues inherent in that process, we prepared this
updated summary with the primary aim of supporting
clinical decision making in applied contexts. This
review builds on existing reviews by (a) organizing
treatments into broad categories based on procedural
and theoretical similarities, (b) offering a systematic
155
classification of indicators of effectiveness that is uni-
form across the literature, and (c) adding two new
strength of evidence levels to expose a number of
potentially promising treatments that failed to meet
more rigorous criteria.
METHOD
Studies of psychosocial and combined treatments from
1965 to 2009 were identified through (a) computerized
searches using electronic databases (e.g., PsycINFO,
Medline, SCOPUS) conducted by a team of over 15
professionals who over a period of four years received
small, monetary rewards for any new study identified
(thus, electronic search terms were not standardized);
(b) evaluation of studies contained in other major liter-
ature reviews (e.g., Silverman & Hinshaw, 2008; Weisz
et al., 2004); (c) personal communication with national
scholars in treatment outcome research; (d) nomina-
tions from members of Hawaii’s Evidence Based Ser-
vices Committee and the Minnesota Department of
Human Services; and (e) e-mail nominations from the
professional community to an online, interactive ver-
sion of earlier reviews. To be included, the study had
to (a) test at least one active psychosocial or combined
treatment relative to a control group, (b) use random
assignment, and (c) report outcome measures at post-
treatment. We excluded articles that described follow-
up evaluations only, universal prevention studies,
uncontrolled efficacy trials, or studies in which the
majority of participants were over the age of 21. Of
over 1,500 articles screened, 413 articles describing 435
studies had sufficient treatment descriptions, compara-
tive outcome data at posttreatment assessments, evi-
dence of random assignment, and were coded. Of
those coded 435 studies, 374 ultimately met the above
eligibility criteria, and 314 of those fell into problem
areas that were a focus of this review (references are
available upon request). With respect to indicators of
clinical severity, 64 studies (14.7%) used both a diag-
nostic measure and a criterion cutoff score on a sepa-
rate measure, 113 studies (26.0%) used diagnosis
only, 128 studies (29.4%) used a cutoff score only,
and 130 (29.9%) used neither a cutoff nor a diagnostic
measure.
Problem areas for review were based on a recent fac-
toring of the treatment literature (Chorpita & Daleiden,
CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE • V18 N2, JUNE 2011
2009) and feedback from the Hawaii committee and
other stakeholders. The final problem areas were the
following: anxiety and avoidance, attention and hyper-
activity, autism spectrum, depression or withdrawal,
disruptive behavior, eating problems, substance use, and
traumatic stress.
Strength of Evidence
We employed a set of standards based in part on the
original standards of APA Division 12. Nevertheless, in
the broader paradigm of knowledge management in
health care (e.g., Graham et al., 2006), the application
of science to practice is characterized by a diversity of
strategies and standards that evolve over time as part of
a broader cycle of knowledge (Frenk, 2009) and that
there are limitations to any single strategy, including
those in the tradition of tallying replications of signi-
ficant contrasts (see Rodgers, 2010). Thus, this 5-level
system is not proposed as a definitive view of the
literature; rather, it is provided as an illustration of a
collectively determined set of standards representing
priorities from a balanced membership of stakeholders
in children’s mental health (including input from
researchers, policymakers, families, and providers.
As in our previous review, the grading uses a 5-
level system, with the first two levels corresponding to
definitions established by the APA Division 12 Task
Force for Promotion and Dissemination of Psychologi-
cal Procedures (1995), with the exception that we did
not consider single-subject designs in this review (see
Table 1). Additional levels to these first two were
added as part of the multiyear stakeholder participation
process outlined previously. Of note is that Level 4 in
the current review refers to interventions that per-
formed better than waitlist in at least one study, which
were not considered distinct from the ‘‘no support’’
group in our previous review. Our new Level 5 refers
to treatments that have been tested but did not per-
form significantly better than any controls. Because
Level 5 treatments are only a small and unrepresenta-
tive sample of the larger population of protocols with-
out support (many of which have never been tested),
their characteristics are not summarized in the results
tables.
Leveling decisions were based on outcomes involv-
ing measures coded as relevant to target symptoms
156

Table 1. Strength of evidence definitions
Level 1: Best Support
I. At least two randomized trials demonstrating efficacy in one or more
of the following ways:
a. Superior to pill placebo, psychological placebo, or another
treatment.
b. Equivalent to all other groups representing at least one Level 1 or
Level 2 treatment in a study with adequate statistical power (30
participants per group on average; cf. Kazdin & Bass, 1989) and
that showed significant pre–post change in the index group as
well as the group(s) being tied. Ties of treatments that have
previously qualified only through ties are ineligible.
II. Experiments must be conducted with treatment manuals.
III. Effects must have been demonstrated by at least two different
investigator teams.
Level 2: Good Support
I. Two experiments showing the treatment is (statistically significantly)
superior to a waiting list or no-treatment control group. Manuals,
specification of sample, and independent investigators are not
required.
OR
II. One between-group design experiment with clear specification of
group, use of manuals, and demonstrating efficacy by either:
a. Superior to pill placebo, psychological placebo, or another
treatment.
b. Equivalent to an established treatment (see qualifying tie
definition above).
Level 3: Moderate Support
One between-group design experiment with clear specification of
group and treatment approach and demonstrating efficacy by either:
a. Superior to pill placebo, psychological placebo, or another
treatment.
b. Equivalent to an already established treatment in experiments
with adequate statistical power (30 participants per group on
average).
Level 4: Minimal Support
One experiment showing the treatment is (statistically significantly)
superior to a waiting list or no-treatment control group. Manuals,
specification of sample, and independent investigators are not
required.
Level 5: No Support
The treatment has been tested in at least one study, but has failed to
meet criteria for levels 1 through 4.
only. Specifically, a treatment had to meet the strength
of evidence requirements on a measure that was
deemed the primary outcome measure for the expected
target of the intervention (e.g., depressed mood in a
study targeting depression). Moreover, coders identified
a single measure from each study determined to be the
‘‘best measure’’ of the target symptoms. In the face of
ambiguity, coders were instructed to select those mea-
sures that had greater frequency of occurrence across
the literature (a rough indicator of higher standardiza-
tion and benchmarking ability). All treatments in a
study were assigned ‘‘leveling contrasts,’’ which
reflected significant outcome differences on this mea-
sure observed between groups. These contrasts were
then aggregated across all studies within a given prob-
EVIDENCE-BASED TREATMENTS FOR CHILDREN AND ADOLESCENTS • CHORPITA ET AL.
lem domain to yield strength of evidence ratings for
each treatment.
Treatments Families
We chose a broad level of analysis for defining treat-
ments such that interventions sharing a majority of
components with similar clinical strategies and theoreti-
cal underpinnings were considered to belong to a single
‘‘treatment family.’’ For example, rather than score each
Cognitive Behavior Therapy protocol for anxiety on its
own (we coded over 40 such protocols for this report),
these were collectively considered a single group that
could achieve a particular level of scientific support,
with many replications. Guided by stakeholder input,
this approach sought a balance of a reliable separation
between constructs of interest in the applied setting and
a focus on ‘‘generic’’ as opposed to ‘‘brand-name’’
treatment modalities when clear empirical justification
for such distinctions did not exist (Chorpita &
Daleiden, 2009; Chorpita & Regan, 2009). Although we
realize that proposing definitions of treatment families
can introduce subjectivity, this position is similar to that
of Rogers and Vismara (2008), who stated that in the
service of the public, ‘‘it would be helpful for treatment
givers to point out commonalities between the brand-
name interventions and others, and to document empiri-
cally the specific generic efficacious practices underlying
the effects in the brand-name program’’ (p. 31).
Although some treatment family labels imply a par-
ticular method of delivery (e.g., Play Therapy) or a
particular treatment audience (e.g., Family Therapy),
our methods typically differentiated these treatment
codes from format codes. For example, relaxation per-
formed with a child and parents together would be
coded in the Relaxation treatment family with Child
and Caregiver(s) as the format and would not be coded
as Family Therapy (which required explicit use of tech-
niques related to that theoretical school). Similarly, not
all treatments that used play were classified as Play
Therapy; rather, Play Therapy referred to treatments
that used play as the primary therapeutic intervention
strategy. Also, when specific treatments were judged to
be unique from a family more generally, these proto-
cols were classified into their own families (hence,
some family therapy approaches are labeled differently
from the default ‘‘family therapy’’ treatment family).
157
Table 2. Effectiveness parameters (clinical utility) characterizing treatment families

Wins ⁄ Ties The number of study groups in which a treatment performed better than one or more other study groups (a psychosocial
treatment, medication, combined psychosocial and medication, placebo, waitlist, no treatment, or other control group) or
had a qualifying tie with one or more evidence-based treatments in a randomized trial on the primary outcome measure in
the target symptom domain. For leveling purposes, only one win ⁄ tie was counted per treatment per study.
Year The year of the most recent study producing a win or tie for an intervention in a particular treatment family.
Trainability An estimate of the degree to which an intervention can be trained easily to others. ‘‘High’’ = manual available AND
treatment was successfully used by nondoctoral-level practitioners; ‘‘Moderate’’ = manual available OR treatment was
successfully used by nondoctoral-level practitioners; ‘‘Low’’ = no manual available AND treatment was successfully used by
doctoral-level practitioners only.
Compliance The average percentage of children who did not drop out of the group (or estimated from the study when not reported by
group) (posttreatment n) ⁄ (pretreatment n). For example, if 6 of 30 children drop out during treatment, compliance = 80%.
Gender Whether boys or girls (or both) were in the treatment group; if information was not reported for a specific treatment
condition, the percentage was estimated using information for the entire study; when the lower percentage was greater
than 30%, the term ‘‘both’’ was used. When the lower percentage was below 30%, the treatment was listed as
representing the majority gender only (e.g., studies that had 75% boys would be displayed as ‘‘boys’’).
Age Range in years since birth (or imputed when only grade level reported); when range was not reported, it was estimated by
using the mean age plus or minus 1.5 SD (approximately 87% of a normal distribution); if no SD was reported, the mean
was used as the minimum and maximum age; if information was not reported for a specific treatment group, these numbers
were estimated using information from the entire study.
Ethnicity Presence of each ethnic group within condition; if information was not reported for a specific treatment condition, this
presence was estimated using information for the entire study under the assumption of the independence of ethnicity and
treatment condition.
Therapist The training, if reported, for the main provider(s) involved within each treatment condition.
Frequency The highest and lowest observed frequency of contact with child ⁄ family, reported in sessions per unit time (e.g., ‘‘weekly’’).
Duration The minimum and maximum length of time from pretreatment to posttreatment.
Format Whether the treatment was group, individual, or some other format of therapy, including whether it included parents or
family, etc.
Setting The primary location types in which treatment was delivered; when setting was not reported, it was sometimes inferred based
on aspects of the treatment (e.g., teacher as therapist implied a school setting).
Effect size The mean effect size of the treatment family, averaging across all study groups within that family (including those that did
not win ⁄ tie), where each group effect size is the difference between pre- and posttreatment group means divided by the
pooled pre- and posttreatment standard deviations on the primary outcome measure.

Indicators of Effectiveness rizes multiple variables pertaining to studies, study

We again followed recommendations of the Task Force
on Psychological Intervention Guidelines, American
Psychological Association (1995) by examining the
aspects of interventions that spoke to their feasibility,
generalizability, and expected benefits (see Table 2). In
our previous review, a number of diverse replications
led to a higher rating on an index of ‘‘robustness,’’
which we no longer report here, owing to concerns
over reliable interpretations of the specialized nature of
a particular protocol. As a compromise, we now report
for each treatment family the actual number of study
groups in which a protocol from that family performed
better than one or more other study groups or tied an
evidence-based treatment in a randomized trial on the
primary outcome measure in the target symptom
domain (see Table 2, ‘‘Wins ⁄ Ties’’).
Coding and Reliability
All studies were coded by two reviewers plus a third
validation judge using the PracticeWise Clinical
Coding System (PracticeWise, 2005), which summa-
groups, and treatment protocols. A study was defined
as a clinical research project in which participants were
randomized to different study groups. A study group
was defined as a set of participants who were random-
ized within a study to receive a defined protocol, such
as a treatment group or a control group. Protocols
were defined as the descriptions of the set of treatment
operations in which members of a particular study
group participated. A single publication could contain
multiple studies (e.g., ‘‘study 1,’’ ‘‘study 2’’), and a sin-
gle study was sometimes summarized across multiple
publications.
Each study and protocol were coded by two raters
who had undergone extensive training in the coding
system, using a detailed coding manual (70 pp.). Once
double coded, information from studies and protocols
was entered into an application that compared all
entries for discrepancies across raters. When the two
raters agreed, these results were written automatically
to a final record, and when raters disagreed, the prob-
lematic field was flagged as a discrepancy for an expert

CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE • V18 N2, JUNE 2011 158
reviewer (i.e., the first or second author), who was
expected to resolve the discrepancy through a third
coding of the relevant study or protocol code. Also, for
the official coded record, all fields were given a final
inspection for accuracy by an expert reviewer and were
subjected to multiple data validation utilities to search
for outliers or other offending values.
Reliabilities for age, gender, ethnicity, problem, and
leveling contrasts were previously reported by Chorpita
and Daleiden (2009) and found to be good. We chose
a random subset of the current sample for reliability
comparisons, and for the new variables in this study
(setting, therapist type, manual used, pre and post n,
means, and SDs, etc.), the reliability coefficients were
also good (j ranged from 0.84 to 1.0, and r ranged
from 0.88 to 1.0).
RESULTS
Anxiety and Avoidance
Review of the treatment outcome studies for childhood
anxiety yielded 17 different treatment families with at
least some level of empirical support (see Table 3). The
vast majority of these studies supported Cognitive
Behavior Therapy (CBT) and its variants as well as
Exposure-based approaches. Not surprisingly, those two
treatment approaches showed the greatest amount of
diversity among participant characteristics, treatment
format, treatment setting, and therapist background, and
had some of the most up-to-date empirical support as
well as large effect sizes. CBT and Exposure were also
rated as highly trainable treatment approaches. Interest-
ingly, a variety of non-cognitive-behavioral treatments
were identified at the new level of ‘‘minimal support,’’
including hypnosis, psychodynamic therapy, biofeed-
back, and play therapy. Although this literature is now
somewhat dated, these early, isolated successes suggest
that further consideration on these diverse approaches
may be warranted (cf. Weisz et al., 2004).
Attention and Hyperactivity
Review of the treatment outcome studies for child-
hood attention and hyperactivity yielded 16 different
treatment approaches with at least some level of empir-
ical support (see Table 4). The best support was evi-
denced by Self-Verbalization (rehearsed overt and then
covert guiding self-statements) and by Behavior Ther-
EVIDENCE-BASED TREATMENTS FOR CHILDREN AND ADOLESCENTS • CHORPITA ET AL.
apy plus Medication, although the effect sizes for these
treatments were relatively small. Notably, the support
for these intervention approaches is not particularly
recent, which may be in part because the effects of
Self-Verbalization were largely measured on cognitive
tasks, and there has been a shift in research emphasis to
behavioral and diagnostic outcomes because of the
emergence of structured diagnostic criteria and
improved measurement of attention. Further, across all
16 identified and supported psychosocial and combined
treatments for childhood attention problems, the num-
ber of clinical trials demonstrating the efficacy of each
treatment is relatively low. Parent Management Train-
ing (alone) showed the largest number of successful
studies. All treatments were relatively short term (i.e.,
ranging from 2 to 12 weeks), with the exception of
Behavior Therapy plus Medication, which averaged
over one year. The majority of treatments were tested
mainly with boys, with only five having been tested in
studies in which at least 30% of the sample was girls.
There were also no studies that included youth above
13 years old. Strengths of the evidence base for atten-
tion problems, however, include that the various sup-
ported treatments for childhood attention problems
span a variety of formats (e.g., group and individual)
and settings (e.g., clinic, home, and school), and are
also deliverable by a range of different therapist types
(e.g., prebachelor’s-level therapists, teachers, and doc-
tors). Although our previous review found insufficient
evidence supporting social skills training, the current
review identified social skills training at the new level
of ‘‘minimal support.’’
Autism Spectrum
Review of the treatment outcome studies for childhood
autism spectrum disorders yielded five different treat-
ment families with at least some level of empirical sup-
port (see Table 5). The best support favored Intensive
Behavioral Treatment and Intensive Communication
Training, although the effect sizes were relatively small.
Both of these treatment approaches were rated as highly
trainable, tested among youths of various ethnic back-
grounds, in various format types (e.g., individual and
group) and settings (e.g., school, clinic, home, and
community), as well as by different therapist types (e.g.,
prebachelor’s-level therapists, master’s-level therapists,
159
 Table 3. Evidence-based treatments for anxiety and avoidance

Treatment Wins ⁄ Compliance Effect

Family Ties Year Train (%) Gender Age Ethnicity Therapist Frequency Duration Format Setting Size

Level 1: Best Support

Cognitive- 42 2008 High 94 Both 4–18 Aboriginal (Australia), Pre-BA, MA, Daily to 1 day to Bibliotherapy, Clinic, 0.85
Behavioral American Indian or MD, PhD, Monthly 24 weeks E-mail, Family, Community
Therapy (CBT) Alaska Native, Asian, Parent, Other Group Client, Field, Day Care,
African American, Individual Client, Home, School
Caucasian, Dutch, Multifamily,
Hindu, Hispanic or Parent and Child,
Latino ⁄ a, Indonesian, Parent Group,
Multiethnic, Other Parent Individual,
Self-Administered,
Teacher Group,

CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE

Telephone Call
Exposure 32 2008 High 97 Both 3–19 Asian, African American, Pre-BA, BA, Daily to 1 day to Group Client, Clinic, 0.70
Caucasian, Hispanic or MA, PhD, Weekly 14 weeks Individual Client, Community
Latino ⁄ a, Multiethnic, Other Parent and Child, Field, Day Care,
Other Parent Group, Hospital, School
Parent Individual
Modeling 9 1984 Moderate 100 Both 3–16 African American, PhD, Teacher, Daily to 1 day to Group Client, Dental Clinic, 0.45
Caucasian Other Semiweekly 6 months Individual Client School
Education 3 1986 Moderate 100 Both 9–13 African American, * Daily to 1 day to Group Client School 0.54
Caucasian Semiweekly 3 weeks
CBT plus 2 2008 Moderate 94 Both 6–15 American Indian or MA, MD, Semiweekly 12 weeks Individual Client, * 1.06

• V18 N2, JUNE 2011

Medication Alaska Native, Asian, Other to Weekly Parent and Child,
African American, Parent Individual
Caucasian, Hispanic
or Latino ⁄ a, Other
Level 2: Good Support
CBT with 3 2008 Moderate 85 Both 4–14 American Indian or MA, PhD Weekly to 12 to Group Client, Clinic 1.24
Parents Alaska Native, Asian, Biweekly 14 weeks Multifamily,
Caucasian, Hispanic Parent Group
or Latino ⁄ a,
Multiethnic
Relaxation 2 1970 Moderate 89 * 14–18 * BA, Other Daily to 1 month to Group Client School *
Semiweekly 8 weeks
Assertiveness 1 1987 Moderate 79 Both 14–15 * * Semiweekly 2 weeks Group Client School *
Training
CBT for Child 1 2003 Moderate 100 * 7–18 Caucasian MA, PhD Weekly 12 weeks Individual Client, Clinic 0.81
and Parent Parent Individual
Family 1 2008 Moderate 78 Both 7–12 Caucasian, Other MA, PhD * 16 weeks Individual Client, Clinic 0.27
Psychoeducation Parent and Child,
Parent Individual
Hypnosis 1 1994 Moderate 100 Both 12–15 * * Weekly 2 weeks Group Client School 1.23

160
 Effect
and doctors). The duration of both Level 1 treatments

0.55

0.77
Size

*
*
was at least a year. Another promising characteristic of
these two approaches is that they were both tested on
Setting

School
School

School
Clinic

Clinic

Clinic
boys as young as one and two years old. None of the
five treatment families, however, were successful among

Individual Client
Individual Client
Group Client youth older than 13 years old, and girls were not well
Group Client

Group Client
represented in any of the studies. Although there were

*
Format

three other treatments that demonstrated some support

for treating children with autism, they were only
assigned the level of ‘‘minimal support.’’
20 weeks

20 weeks

12 weeks
17 weeks
Duration

8 weeks

5 weeks
Depression and Withdrawal
Review of the treatment outcome studies for childhood
Semiweekly

Semiweekly
Frequency

depression yielded 10 different treatment families with at

Weekly

Weekly

Weekly

Weekly

least some level of empirical support (see Table 6). The

best supported were Cognitive Behavior Therapy
(CBT) and its variants (i.e., CBT plus Medication, CBT
Therapist

MA, MD

Teacher
Other

Other

with Parents), which also showed the greatest amount of

PhD

BA

diversity among treatment formats (e.g., child ⁄ parent

individual, child ⁄ parent group, telephone and self-
African American,

administered) and large effect sizes. Interestingly, Family

Caucasian

Therapy also appeared in Level 1 for ‘‘Best Support,’’

Caucasian

Caucasian

Caucasian
*
*
Ethnicity

based on studies in 2002 and 2007, despite having no

support in our previous review (Chorpita et al., 2002).
Notes. Train = Trainability. *Information could not be determined from the published reports.

Among the four treatments at Level 1, only CBT was

7–9

7–9

12–14
6–11
6–15

10–12
Age

rated as highly trainable. The majority of treatment

approaches were supported across multiple ethnicities,
Gender

therapist types (e.g., prebachelor’s-level therapists to

Male

Male

Both
Both

Both
*

doctors), and on both men and women. No studies

reported successful tests of CBT with children younger
Compliance

than eight years old. The previous literature review did

not find sufficient evidence in support of Self-Control
(%)

100

100

96
100
100

100

Training and Self-Modeling, but these are now identi-

fied at the new level of ‘‘minimal support.’’
Moderate
*

*
Train

High
Low

Disruptive Behavior
Review of the treatment outcome studies for childhood
1970

1970

1996
1970
1972

1976
Year

disruptive behavior yielded 23 different treatment

approaches with at least some level of empirical support
Wins ⁄
Ties

(see Table 7). Across all of the problem areas reviewed,

Level 3: Moderate Support
1

1
1
1

1
Level 4: Minimal Support

this was the area for which we identified the greatest

Table 3. (Continued)

Emotive Therapy

number of supported treatments. Parent Management

Psychodynamic
Group Therapy
Management

Play Therapy

Training (PMT) was the only treatment supported at

Contingency

Biofeedback

Level 1 in our previous review, whereas six treatments

Rational
Treatment
Family

received that level of support in the current review.

Nevertheless, the vast majority of positive findings

EVIDENCE-BASED TREATMENTS FOR CHILDREN AND ADOLESCENTS • CHORPITA ET AL. 161

 Table 4. Evidence-based treatments for attention and hyperactivity

Wins ⁄ Compliance Effect

Treatment Family Ties Year Train (%) Gender Age Ethnicity Therapist Frequency Duration Format Setting Size

Level 1: Best Support

Self-Verbalization 4 1982 Moderate 100 Both 7–13 Caucasian Other Daily to 2 days to Individual Client Clinic, School 0.31
Semiweekly 2 weeks
Behavior Therapy 3 1999 Moderate 86 Male 7–11 African American, MA, MD, Daily to 12 weeks to Group Client, Clinic, 0.09
plus Medication Caucasian, Teacher Biweekly 426 days Individual Client, Community
Hispanic or Multifamily, Field
Latino ⁄ a Parent and Child,
Parent Group
Level 2: Good Support
Parent Management 5 2001 High 100 Male 2–12 * BA, Other Weekly 6–12 week Parent and Child, Clinic, Home 0.92
Training (PMT) Parent Group

CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE

Physical Exercise 3 1995 High 97 Male 6–13 * MA Semiweekly 3–4 weeks Group Client, Partial 0.83
to Weekly Individual Client, Hospital,
Parent Individual School
Biofeedback 2 1982 Moderate 100 Male 7–12 * PhD * 12 weeks Individual Client School 0.67
Contingency 2 1991 High 100 Both 6–10 Caucasian Pre-BA, Semiweekly 10 weeks Group Client School 2.00
Management Teacher
PMT and Teacher 2 2007 Moderate 100 Both 5–12 Asian, MA, PhD Weekly 10–12 weeks Fax to Teacher, Clinic 0.80
Psychoeducation African American, Group Client,
Caucasian, Hispanic Multifamily,
or Latino ⁄ a, Parent Group
Multiethnic

• V18 N2, JUNE 2011

Social Skills plus 2 1984 High 100 Male 8–13 * Pre-BA, Daily 2 weeks Group Client School *
Medication MA
Education 1 2001 Moderate 100 Male 6–12 Caucasian * Daily 3–5 weeks Computer * *
Administered
PMT and Problem 1 1991 Moderate 100 Male 7–13 * * Semiweekly * Family, Individual Clinic, Home 0.68
Solving Client
Relaxation and 1 1984 High 100 Male 6–8 * MA Weekly 3 weeks Group Client * 2.21
Physical Exercise
Working Memory 1 2005 High 85 Male 7–11 * * Semiweekly 5–6 weeks Self-Administered Home, School 0.26
Training
Level 4: Minimal Support
PMT and Social 1 1997 Moderate 100 Both 8–10 African American, BA, PhD Biweekly 8 weeks Group Client, Clinic 0.78
Skills Caucasian Parent Group
Relaxation 1 1977 Moderate 100 Male 8–9 * * * 3 weeks Individual Client School *
Self-Verbalization 1 2002 High 100 Male 8–9 Caucasian Teacher * * Group Client School 0.87
and Contingency
Management
Social Skills 1 1997 Moderate 100 Both 8–10 African American, BA, PhD Weekly 8 weeks * Clinic 0.51
Caucasian

Notes. Train = Trainability. *Information could not be determined from the published reports.

162
 Effect continue to support PMT, which also demonstrated the

0.28

0.49

1.67

0.55

1.48
Size largest effect size of any Level 1 treatment. Several treat-

Field, Day Care,

ment families were successful with both boys and girls as

Home, School

Clinic, School
Community
well as across a wide range of ethnicities, in contrast to

Day Care
*
our previous review for which the identified supported
Setting

Clinic,

Clinic
treatments were successful with samples that were pri-
marily boys and limited in ethnic diversity. All six Level

Parent Individual,
Parent and Child,
1,917 days Individual Client,

Individual Client,

Parent Individual
Parent Group,
1 treatments were also rated as highly trainable and were
Parent Group

Parent Group
Parent Group,
5 weeks to Group Client,

152 days to Group Client,

Group Client,

Group Client
tested across a wide range of ages (i.e., ages 2–18), for-
Format

Other mats (e.g., family, parent group, individual client, and

self-administered), and settings (e.g., clinic, home, hos-
pital, and school). Interestingly, although group treat-
24 weeks

13 weeks
Duration

9 weeks
ments for children have been shown to involve risks
1 year

(e.g., Dishion, McCord, & Poulin, 1999), the majority

of all 23 identified treatment families were successful
Semiweekly
Bimonthly

Weekly to

Weekly to
Frequency

Monthly

with a group format component included.

Weekly
Pre-BA, MA, Daily to

Daily to

Weekly

Eating Problems
African American, MD, PhD,

Review of the treatment outcome studies for child-

Teacher,
Therapist

1–10 African American, BA, MA,

Teacher
Other

Other

hood eating problems (e.g., anorexia and bulimia)

PhD

MA

yielded three different treatment approaches with

empirical support indicated by one or two RCTs (see
Caucasian, Other
Latino ⁄ a, Other

Table 8). All three treatments were supported at Level

Hispanic or
Caucasian,

2 (‘‘Good Support’’), involved either CBT or family-

*

*
Ethnicity

Notes. Train = Trainability. *Information could not be determined from the published reports.

based interventions, and were rated as moderately train-

2–12 Asian,

able. The higher degree of specialized skill involved in

8–13

2–9

3–4

treating youths with eating problems is suggested by

Gender Age

the finding that the therapist type of the supported

Male

Male

Male

Male

Male

treatments were of master’s level or above, in contrast

to the range of therapists’ background for supported
Compliance

treatments of other problem areas. The specialized nat-

ure of this problem area is further highlighted by the
(%)

100

93

2007 Moderate 100

100

2005 Moderate 100

findings that all three treatment types were tested in

Table 5. Evidence-based treatments for autism spectrum

clinics only. CBT was only tested among Caucasian

Train

2006 High

2007 High

2009 High

youth, demonstrating the need for CBT to be tested

among youth from a wider range of ethnic back-
Year

grounds. All three supported treatments were successful

primarily with girls, ranging from 10 to 20 years old.
Wins ⁄
Ties

Intensive Communication 3

Substance Use
Level 4: Minimal Support

Review of the treatment outcome studies for child-

Parent Management
Intensive Behavioral
Level 1: Best Support

Cognitive Behavior

hood substance use yielded eight different treatment

Treatment Family

approaches with some level of empirical support (see

Peer Pairing
Treatment

Therapy
Training

Training

Table 9). The best support was evidenced by Family

Therapy, which was found to be highly trainable,
tested primarily on boys aged 6–21 from a variety of

EVIDENCE-BASED TREATMENTS FOR CHILDREN AND ADOLESCENTS • CHORPITA ET AL. 163

 Table 6. Evidence-based treatments for depression and withdrawal

Wins ⁄ Compliance Effect

Treatment Family Ties Year Train (%) Gender Age Ethnicity Therapist Frequency Duration Format Setting Size

Level 1: Best Support

Cognitive Behavior 15 2007 High 94 Both 8–23 American Indian Pre-BA, BA, Semiweekly 4–16 weeks Group Client, Clinic, 0.87
Therapy or Alaska Native, MA, PhD to Weekly Individual Client, School
Asian, African American, Self-Administered,
Caucasian, Hispanic or Telephone Call,
Latino ⁄ a, Multiethnic, Other
Puerto Rican National,

CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE

Other
Cognitive Behavior 3 2008 Moderate 94 Both 12–21 Asian, African American, MA, MD, PhD Semiweekly 12 weeks to Individual Client, Clinic 1.47
Therapy plus Caucasian, Hispanic or to Weekly 6 months Parent and Child,
Medication Latino ⁄ a, Multiethnic, Parent Individual
Other
Cognitive Behavior 3 2008 Moderate 95 Both 13–18 Caucasian, Other BA, MA, MD, Semiweekly 8–12 weeks Group Client, Clinic 0.95
Therapy with Parents PhD to Biweekly Individual Client,
Parent and Child,
Parent Group
Family Therapy 2 2007 Moderate 100 Both 10–17 Asian, African American, MA, PhD Weekly to 12 weeks to Family, Individual Clinic 0.97
Caucasian, Other Monthly 9 months Client

• V18 N2, JUNE 2011

Level 2: Good Support
Interpersonal Therapy 3 2004 Moderate 90 Female 12–18 Hispanic or Latino ⁄ a, MA, MD, PhD Weekly 12–16 weeks Individual Client Clinic, 0.99
Puerto Rican National School
Expressive Writing ⁄ 2 2006 * 100 Both 15–22 Asian, African American, * Weekly to 3–4 weeks Individual Client Clinic, 0.46
Journaling ⁄ Diary Caucasian, Hispanic or Biweekly Home
Latino ⁄ a, Multiethnic,
Other
Relaxation 2 1990 Moderate 86 Both 10–18 Caucasian MA, PhD Semiweekly 5–8 weeks Group Client School 1.14
Client-Centered 1 2006 High 100 Both 15–22 Asian, African American, Pre-BA, MA Weekly 4 weeks Group Client School 0.96
Therapy Caucasian, Hispanic or
Latino ⁄ a, Multiethnic,
Other
Level 4: Minimal Support
Self-Control Training 1 1987 Moderate 100 Both 9–12 * MA, PhD Semiweekly 5 weeks Group Client School 1.43
Self-Modeling 1 1990 Moderate 100 Both 10–14 * MA, PhD Semiweekly 6–8 weeks Individual Client School 0.85

Notes. Train = Trainability. *Information could not be determined from the published reports.

164
 Table 7. Evidence-based treatments for disruptive behavior

Wins ⁄ Compliance Effect

Treatment Family Ties Year Train (%) Gender Age Ethnicity Therapist Frequency Duration Format Setting Size

Level 1: Best Support

Parent 41 2008 High 93 Male 2–15 Asian, Australian, Pre-BA, BA, Daily to 1 day to
Family, Group Client, Clinic, Home, 0.98
Management Australian Koori, MA, PhD, Weekly 2 yearsMultifamily, Parent Hospital,
Training (PMT) African American, Teacher, and Child, Parent Playroom,
Caucasian, Hispanic Parent, Other Group, Parent School,
or Latino ⁄ a, Multiethnic, Individual, Phone Undergraduate
Norwegian or Western Sessions ⁄ Videotape University
European Instruction, Course
Self-Administered
Multisystemic 9 2006 High 95 Male 10–17 Asian, African American, BA, MA, MD, Daily to 5 weeks to Family, Individual Community Field, 0.46
Therapy Caucasian, Hispanic or Other Weekly 438 days Client, Parent and Home, Hospital,
Latino ⁄ a, Multiethnic Child, Parent School
Individual
Social Skills 7 2001 High 98 Both 4–19 American Indian or MA, PhD Daily to 3–22 weeks Group Client Clinic, 0.60
Alaska Native, Asian, Weekly Community
African American, Residential,
Caucasian, Hispanic or Corrections,
Latino ⁄ a, Other Day Treatment
Center, School
Cognitive Behavior 4 2004 High 100 Both 9–18 American Indian or MA, PhD, Other Semiweekly 6–12 weeks Group Client Corrections, 0.57
Therapy Alaska Native, Asian, to Weekly School
African American,
Caucasian, Hispanic or
Latino ⁄ a
Assertiveness 3 1999 High 100 Both 13–18 African American, Other Semiweekly 2–4 weeks Group Client, Peer Hospital, School 0.27
Training Caucasian, Hispanic or
Latino ⁄ a, Multiethnic
PMT and Problem 3 2007 High 89 Male 0–13 African American, BA, MA Weekly to 12 weeks to Family, Group Client, Clinic, Hospital 0.98
Solving Caucasian Biweekly 8 months Individual Client,
Parent Group,

EVIDENCE-BASED TREATMENTS FOR CHILDREN AND ADOLESCENTS • CHORPITA ET AL.

Parent Individual
Level 2: Good Support
Problem Solving 7 2000 High 96 Male 5–17 African American, BA, MA, PhD, Semiweekly 45 days to Bibliotherapy, Group Home, Hospital, 0.52
Caucasian, Israeli Other to Weekly 20 weeks Client, Individual School
(Jewish, Arab, and Client
Druz)
Communication 5 1988 Moderate 92 Male 6–16 * BA, MA, PhD Weekly 4–7 weeks
Family, Multifamily, Clinic 1.27
Skills Parent and Child,
Parent Individual,
Other
Contingency 5 1991 High 100 Male 4–19 African American, Pre-BA, BA, MA, Semiweekly 4–20 weeks Group Client, Clinic, 1.08
Management Caucasian PhD, Teacher, to Weekly Individual Client Corrections,
Other Hospital,
School

165
 Table 7. (Continued)

Wins ⁄ Compliance Effect

Treatment Family Ties Year Train (%) Gender Age Ethnicity Therapist Frequency Duration Format Setting Size

Anger Control 4 1993 Moderate 87 Male 9–21 American Indian or MA, PhD, Other Semiweekly 5–12 weeks Group Client, Corrections, 0.20
Alaska Native, Asian, to Weekly Individual Client School
African American,
Caucasian, Hispanic or
Latino ⁄ a
Relaxation 2 1986 Moderate 100 Both 9–18 * MA Daily to 5 weeks Individual Client Corrections, 0.62
Semiweekly to 80 days School
Therapeutic Foster 2 2005 Moderate 100 Both 12–17 American Indian or Other Daily 174 days Family, Foster Foster Home 0.80
Care Alaska Native, Asian, Care, Individual

CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE

African American, Client, Parent
Caucasian, Hispanic or Group, Parent
Latino ⁄ a, Other Individual
Functional Family 1 1973 High 74 Both 13–16 * MA * 5–6 weeks * * *
Therapy
Parent Management 1 2007 * 100 Both 5–6 Asian, African American, Teacher, Semiweekly 2 years Group Client, School 0.25
Training and Classroom Caucasian, Hispanic or Other to Weekly Parent Group
Contingency Management Latino ⁄ a, Other
Rational Emotive 1 1978 High 100 Both 15–17 African American, MA Daily 12 weeks Group Client School 2.45
Therapy Hispanic or Latino ⁄ a
Transactional 1 1975 Moderate 97 Male 15–17 African American, MA, Other Semiweekly 30 weeks Group Client Corrections *

• V18 N2, JUNE 2011

Analysis Caucasian, Hispanic or
Latino ⁄ a, Other
Level 3: Moderate Support
Attention 1 1966 * 100 Female 14–18 * * Semiweekly 3 months Group Client Corrections *
Outreach Counseling 1 1978 Moderate 100 * * * MA, Other * * * Community *
Field
Peer Pairing 1 1982 Moderate 100 Both 15–18 * Teacher Semiweekly 7 weeks Group Client, School *
Individual
Client
Self-Control Training 1 1979 Low 100 * 14–17 African American, PhD Weekly to 4 weeks Group Client, Community 0.30
Caucasian, Ethnicity Semiweekly Individual Residential
Other: Puerto Rican, Client
Hispanic or Latino ⁄ a
Level 4: Minimal Support
Parent Management 1 2004 Moderate 100 Both 6–12 African American, Other * * Group Client, Community 0.02
Training and Caucasian Parent Field, Home,
Self-Verbalization Individual School
Physical Exercise 1 1995 * 91 Male 7–13 * * Semiweekly 4 weeks Group Client Partial Hospital *
Stress Inoculation 1 1981 High 100 Male 13–18 * MA Semiweekly 5 weeks Individual Client Corrections 0.63

Notes. Train = Trainability. *Information could not be determined from the published reports.

166
 Effect
ethnic backgrounds and associated with the largest

1.16

0.90

0.41
Size
effect size across all supported treatments for childhood
substance use. The majority of the supported treat-
Setting

Clinic

Clinic
*
ments were rated as highly trainable, demonstrating
promise with respect to their implementation and

Individual Client,
effectiveness in nonclinic settings. In fact, a few of

Parent and
these treatments were successful in schools, and
Format

Family

Family

Child
Motivational Interviewing ⁄ Engagement demonstrated
6 months to effectiveness in a community setting.
1.5 years

6 months
1 year to
Duration

Traumatic Stress
1 year

Review of the treatment outcome studies for childhood

traumatic stress yielded four different treatment
Bimonthly
Weekly to

Weekly to

Weekly to
Frequency

approaches with at least some level of empirical support

Monthly

Monthly

(see Table 10). The best support for treating childhood

traumatic stress was evidenced by Cognitive Behavior
Therapy (CBT) with Parents. The compliance rate was
MD, PhD
MA, PhD
Therapist

high for CBT with Parents, and this treatment was tested
across a wide age range (i.e., youth ages 2–17). Notably,
Caucasian, Middle

CBT with Parents was tested among samples that were

African American,

primarily girls. Interestingly, as seen in the anxiety prob-

Hispanic or
Caucasian,

Caucasian
Latino ⁄ a

lems literature, two noncognitive behavioral treatments

Ethnicity

Eastern

were identified at the new level of ‘‘minimal support,’’

including Play Therapy and Psychodrama. Each was
Notes. Train = Trainability. *Information could not be determined from the published reports.
11–20

11–19

13–20

supported by only one clinical trial, but suggests that fur-

Age

ther study of these approaches may be warranted. For

instance, Play Therapy was tested only among Chinese
Gender

Female

Female

Female

nationals; clinical trials conducted on youth of other eth-

nicities and nationalities may further inform us. Notably,
Compliance

the CBT-based treatments supported at Level 1 and

Level 2 were rated as highly trainable, whereas both Psy-
(%)

100

92

70

chodrama and Play Therapy were rated as only moder-

ately trainable. Lastly, it is worth noting that CBT
Moderate

Moderate

Moderate
Table 8. Evidence-based treatments for eating problems

(alone ⁄ with parent involvement) demonstrated ‘‘good’’

Train

support and was associated with the largest effect size.

Although the inclusion of parents in CBT treatment for
1999

2007

2007
Year

youth with traumatic problems has the most support, the

present findings indicate that individual CBT would
Wins ⁄
Ties

nevertheless be a reasonable course of action, particularly

2

given its larger effect size and greater diversity of set-

Family Systems Therapy

tings.
Level 2: Good Support

Cognitive Behavior
Treatment Family

Family Therapy

DISCUSSION
Therapy

Overall, the literature points to an array of approaches

for child and adolescent mental health concerns, even
when individual protocols are aggregated into treatment

EVIDENCE-BASED TREATMENTS FOR CHILDREN AND ADOLESCENTS • CHORPITA ET AL. 167

 Table 9. Evidence-based treatments for substance use

Wins ⁄ Compliance Effect

Treatment Family Ties Year Train (%) Gender Age Ethnicity Therapist Frequency Duration Format Setting Size

Level 1: Best Support

Family Therapy 3 2001 High 100 Male 6–21 Asian, African American, MA, PhD Weekly 3 weeks to Family, Individual Clinic 0.71
Caucasian, Hispanic or 6 months Client, Parent

CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE

Latino ⁄ a, Other Individual
Level 2: Good Support
Cognitive Behavior 3 2006 High 62 Both 13–18 Caucasian BA, MA, Weekly 2–12 weeks Group Client School 0.55
Therapy PhD
Motivational 2 2006 High 100 Both 14–20 American Indian or MA Daily 1 day Individual Client Community 0.13
Interviewing ⁄ Alaska Native, Asian, Field
Engagement African American,
Caucasian, Hispanic or
Latino ⁄ a, Multiethnic,
Pacific Islander, Other
Contingency 1 1994 High 100 Male 13–18 African American, BA, MA Semiweekly 6 months Parent and Child Clinic 0.48
Management Caucasian, Hispanic or

• V18 N2, JUNE 2011

Latino ⁄ a
Family Systems 1 1992 High 78 * 11–20 African American, MA Weekly 7–15 weeks Family Clinic *
Therapy Caucasian, Hispanic or
Latino ⁄ a
Goal Setting ⁄ 1 2007 Moderate 100 Both 14–17 Caucasian, Other * Weekly 3 weeks Individual Client, School 0.46
Monitoring Parent Individual
Purdue Brief Family 1 1990 Moderate 100 Male 12–22 * * * 12 weeks Family * *
Therapy
Level 4: Minimal Support
Goal Setting 1 2007 Moderate 100 Both 14–17 Caucasian, Other * Weekly 2 weeks Individual Client School 0.34

Notes. Train = Trainability. *Information could not be determined from the published reports.

168
 Effect
family groupings as we have chosen to do in this report.

0.79

1.16

0.52
Size

*
This greater number of treatments is attributed to a num-

Corrections,
ber of factors, including the 128 new treatment outcome
studies published since the year 2000, which included a

School
Setting

School
School
Clinic,
Clinic growing body of international treatment outcome
Parent and Child,
Parent Individual research. Methodological changes, including a new, less-

Individual Client
Individual Client,

stringent strength of evidence level (Level 4), added 19

Group Client,

Group Client
Group Client
new treatment families to the report. We see the current
results as useful in guiding therapists to choose among
Format

treatment families, balancing consideration of both

20 weeks strength of evidence ratings and information related to
Duration

4 weeks
weeks

weeks

the clinical utility of the approaches. Although behav-

12–20

8–20

ioral and cognitive-behavioral treatments were successful

across problem areas, proclaiming behavioral and cogni-
Semiweekly to

Semiweekly

tive-behavioral treatments as the ‘‘clear winners’’ may be

Frequency

Weekly

Weekly

Weekly

too narrow and limiting, particularly in the contexts of

promoting family choice, fitting treatment plans to spe-
cific family preferences and values, and when informing
MA, PhD,

MA, PhD,
Therapist

Other

Other

decisions about revising treatment plans in the face of

Other
MA

poor outcomes with frontline approaches. These findings

extend and complement recent reviews from APA Divi-
Caucasian, Hispanic

Caucasian, Hispanic
or Latino ⁄ a, Other
Multiethnic, Other
African American,

African American,

African American,

sion 53 (Silverman & Hinshaw, 2008) in that (a) they

Latino ⁄ a, Other
Chinese National
or Latino ⁄ a,

organize specific treatments into broader categories (thus

Hispanic or
Ethnicity

providing some evidence for the robustness of many of

Notes. Train = Trainability. *Information could not be determined from the published reports.

these approaches to minor variations), (b) they apply a

single framework to catalog indicators regarding treat-
2–18

5–18

8–12
11–13

ment effectiveness (i.e., feasibility, generalizability, and

Age

effect size), and (c) they identify overall a larger number

Gender

Female

Female

of successful treatments both because of a larger number

Both

Both

of RCTs reviewed as well as the expansion of leveling

Compliance

criteria to include promising treatments with less support

(Levels 3 and 4) than would be identified by earlier
(%)

94

93

100
92
Table 10. Evidence-based treatments for traumatic stress

standards.
We continue to assert that there is more informa-
Moderate
Moderate

tion in the treatment outcome literature than can be

Train

High

High

easily applied to decision making in applied contexts.

Given the many details that characterize different treat-
2004

2007

2002
1999
Year

ments and the diverse client characteristics to which

those treatments presumably must be matched, we see
Wins ⁄
Ties

an increasing need for research on clinician judgment

4

1
1
Level 4: Minimal Support

and decision making in the application of evidence-

Therapy (CBT) with

Level 2: Good Support

Level 1: Best Support
Cognitive Behavior

based treatments. Further, the results of this review

Treatment Family

Psychodrama
Play Therapy

represent only one view of that complex literature and,

for example, do not address questions related to prac-
Parents

tice components or elements (Chorpita & Daleiden,

CBT

2009), risks and side effects associated with treatments,

EVIDENCE-BASED TREATMENTS FOR CHILDREN AND ADOLESCENTS • CHORPITA ET AL. 169

generalizability of the literature to actual service popula-
tions (i.e., who is and is not covered by the literature
and why; Schiffman, Becker, & Daleiden, 2001), idio-
graphic outcomes found in experimental single-subject
designs, or durability of treatments as reflected in reviews
addressing long-term follow-up outcomes. Particularly
given that the literature is still characterized by many
gaps in terms of demonstrations of treatment applicabi-
lity to specific groups (Kazdin, 2008), we feel that multi-
ple, complementary views of the literature remain
important, especially involving decisions about extend-
ing findings to new populations or contexts in the face
of limited information (e.g., what to do with a 16-year-
old child with hyperactivity). There is a constant tension
between breadth and depth in review efforts, and there
is clearly no single best way to focus the lens. Moreover,
how these multiple views can best be incorporated into
clinical decisions is not well understood and thus an
important topic for future research.
The methodology influencing this particular sum-
mary of the literature was developed primarily at a time
when evidence-based practice was an emerging para-
digm, and as such there are some aspects of this meth-
odology that may warrant significant revision as the
literature continues to grow. For example, the litera-
ture is now increasingly characterized by studies with
stronger designs (i.e., tests against active treatments)
and improved measurement. Thus, it may be that Level
4 treatments (those that outperformed waitlist) would
add few if any new treatments over the next 10 years
and thus could eventually become a historical category
more than anything else. Relatedly, even in compara-
tive outcome studies, the current methodology does
not apply different strength of evidence levels based on
the nature of the alternative treatment, and yet presum-
ably our decisions in the future will be increasingly
focused on those options that are likely to be more
promising than treatment as usual, and not simply
attentional, placebo, or other inert controls (see Weisz,
Jensen-Doss, & Hawley, 2006).
A specific limitation of our coding system in light of
the evolving literature is the lack of coding of imple-
mentation-related variables, which are rarely reported
in early studies but are increasingly described in more
recent ones. Such information (inclusive of the avail-
ability of training resources, supervision requirements,
CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE • V18 N2, JUNE 2011
and overall training demand) would presumably be
helpful in serving the mission of selection and install-
ment of evidence-based treatments. Another limitation
was the use of a coded-nominated ‘‘best measures’’ to
determine the outcome measure on which the leveling
assignments were based. We know of no clear standard
on how to operationalize a treatment outperforming a
control group in terms of algorithms for inspecting
significant contrasts among multiple measures (see
Chambless & Hollon, 1998), although the trend
appears to be to count studies in which at least one
measure of the target construct demonstrated a statisti-
cally significant effect (e.g., Eyberg, Nelson, & Boggs,
2008; who also summarized the total number of mea-
sures tested to add useful perspective). In this review,
we used a somewhat conservative criterion by agreeing
a priori on a single measure per study to evaluate (i.e.,
our coding procedures prioritized those that are most
widely used in the literature), but this conservatism had
greater potential for subjectivity. Future research should
evaluate the effects of various operational definitions of
significant effects (e.g., sufficiency, ‘‘best measure,’’ and
meta-analytic approaches) to determine the potential
biases inherent in each.
Another general limitation of this review is the lack
of review of studies with single-subject designs. This
decision stems from the trade-off between the practical
considerations of identifying and coding such studies
and the utility of the information obtained through
review. We noted that in the series of reviews by APA
Division 53 (Silverman & Hinshaw, 2008), some
reviews included single-subject designs (Pelham &
Fabiano, 2008; Rogers & Vismara, 2008), whereas
other did not (e.g., Silverman, Pina, & Viswesvaran,
2008). These methodological decisions appeared to be
tied to the same logic as our own: reviews with a
greater number of RCTs were less likely to include
single-subject designs, and reviews with a smaller num-
ber were more likely to include single-subject designs.
Although the literatures with a high number of RCT
provide sufficient information to provide reliable and
sometimes plentiful treatment recommendations, they
(as does our review) nevertheless may underrepresent the
list of what treatments work. A comprehensive review of
both randomized group and single-subject experimental
designs—albeit an enormous undertaking—would be an
170
important advance in summarizing more completely
the scientific evidence supporting various treatment
approaches.
Regarding the noted improvements in measurement
and other standards in more recent studies, we may need
to reconsider for future reviews whether to aggregate
newer, more precise findings with those from studies
that may have used methods that would not be consid-
ered of sufficient quality today. Such an approach was
taken in the reviews by APA Division 53 (Silverman &
Hinshaw, 2008), which employed research quality stan-
dards by Nathan and Gorman (2002) in conjunction
with Division 12 criteria for defining EBTs. This raises
the kind of trade-offs common to the signal detection
paradigm (i.e., filtering out the unwanted noise while
filtering in the desired signal), with more conservative
filters (i.e., those that prioritize filtering out over filtering
in) yielding better quality, but fewer studies. As the 2008
Division 53 reviews demonstrate, no single standard is
likely to fit all contexts (e.g., some reviews used studies
only from Level 1 of the 6 levels outlined by Nathan
and Gorman, 2002, whereas other reviews used Levels
1, 2, and 3), and less-developed literatures are likely to
need more relaxed standards. We believe this problem is
best handled through the application of multiple cutoffs
(e.g., partially addressed by a 5-level system) that allow
for higher standards to be enforced in well-developed
areas of the literature and (temporarily) lower standards
in others.
The notion of an increasing standard of evidence
raises the larger issue that most approaches to defining
evidence-based treatment are confirmatory in nature
—that is, treatments can only move up and not down in
strength of evidence levels. Given the lack of good infor-
mation overall and the relatively small treatment out-
come literature for children and adolescents, it seems a
reasonable policy decision for now to err on the side of
potentially overapplying existing findings rather than un-
derutilizing available evidence because even given our
best efforts, we still think that evidence is underutilized
in applied settings. Nevertheless, it does raise the issue
that the ability to select among treatments could eventu-
ally be complicated by an overly complex array of
choices, and continued reviews that summarize features
related to effectiveness (such as this review) as well as
quantitative meta-analyses (e.g., Weisz et al., 1995) will
EVIDENCE-BASED TREATMENTS FOR CHILDREN AND ADOLESCENTS • CHORPITA ET AL.
become increasingly necessary in guiding choices among
a list of evidence-based practices that can only get longer
by current definitions.
That said, at this point in time, we see the value of
reviews that provide a balanced emphasis on efficacy
and effectiveness that will lead to greater availability of
information relevant to decisions about treatment selec-
tion and adaptation. This review presents mostly good
news: there are hundreds of evidence-based practices
that can be grouped into dozens of treatment families
addressing a large array of common childhood mental
health problems. Although notable gaps in the litera-
ture remain, there is a clear trend that those gaps are
being filled and that both providers and families can
look forward to a future involving even more choices
guided by even richer information. The research com-
munity will need to continue to focus on analytic
methods that will best organize and translate that
ever-developing knowledge into practice.
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